Retroperitoneal Extramedullary Relapse after Blinatumomab in Acute Lymphoblastic Leukemia Failing a Haplo-Identical Bone Marrow Transplantation

Clinical Image

Ann Hematol Oncol. 2017; 4(8): 1166.

Retroperitoneal Extramedullary Relapse after Blinatumomab in Acute Lymphoblastic Leukemia Failing a Haplo-Identical Bone Marrow Transplantation

Marano L¹, Venetucci P², Macera A², Beneduce G¹, Grimaldi F¹ and Risitano AM¹*

¹Hematology and BMT Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy

²Interventional Radiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy

*Corresponding author: Antonio M. Risitano, Head of BMT Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini 5 80131 Naples, Italy

Received: July 03, 2017; Accepted: July 17, 2017; Published: August 04, 2017

Clinical Image

CT scan (Figure 1A) and fine-needle aspirate (Figure 1B) of retroperitoneal lesions in an acute B-cell lymphoblastic leukemia (B-ALL) patient treated with blinatumomab for post-transplant relapse. This 43 year old man has received allogeneic hematopoietic stem cell transplantation (HSCT) from a haplo-identical donor (according to the Genoa’s protocol exploiting high dose posttransplant cyclophosphamide); due to early hematological relapse he received further chemotherapy, followed by 4 courses of blinatumomab, achieving complete hematological response (including no detectable minimal residual disease [MRD] by flow cytometry). Due to the high risk of relapse, he then received two donor lymphocyte infusions (1x106/kg and 5x106/kg, with a 4 week interval). One week after the second DLI (while MRD became 0.06%), he developed grade II graft versus host disease (GvHD; skin II, liver I) with severe abdominal pain, raising the differential diagnosis between intestinal involvement of GvHD and other conditions. CT scans (Figure 1A) showed multiple intra and retro peritoneal soft tissue lesions some of which with a clear nodular appearance without any fluid collection. The white arrow indicates the retroperitoneal target lesion of FNAB. The fine-needle aspirate showed a solid tissue, which at the May-Grünwald-Giemsa staining appeared entirely formed by mid-size lymphoblasts (Figure 1B); immunophenotype was the same of initial diagnosis (including CD19 expression). The final diagnosis of extramedullary relapse was made, and the patient started a salvage treatment, which could not prevent disease progression and death.

Citation:Marano L, Venetucci P, Macera A, Beneduce G, Grimaldi F and Risitano AM. Retroperitoneal Extramedullary Relapse after Blinatumomab in Acute Lymphoblastic Leukemia Failing a Haplo-Identical Bone Marrow Transplantation. Ann Hematol Oncol. 2017; 4(8): 1166. ISSN:2375-7965